Should gtube feeding bags be rinsed between feedings?

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Hello fellow lovely nurses!

I got into an argument with a co worker the other day. This pt has two gtube feedings; one at 1000 and one at 1400. Normally I will run the pts feeding and leave the bag alone after it is done infusing. Then I add the other can to the bag and let that infuse. I always flush the actual gtube with water to hydrate the pt, as prescribed. The nurse I work with mixes water into the feeding bag when it is done and primes the mixture into the pt. She told me I was putting the pt in danger by not rinsing out the bag, but I really don't think it's necessary to clean the bag in between if it's only 4 hrs. At my home health case I sometimes will put all the cans for the day in one feeding bag and put it on an ice pack. What do you think?

Specializes in Acute Care Pediatrics.

I would never use a bag for a bolus feed, for this reason alone. Is this patient having to run an amount over a period of time? If I was doing feeds Q4, I'd hopefully be able to do them to gravity and use my trusty toomey syringe. :)

Bags are hung and changed Q24 for continuous.

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Specializes in Complex pedi to LTC/SA & now a manager.
I would never use a bag for a bolus feed, for this reason alone. Is this patient having to run an amount over a period of time? If I was doing feeds Q4, I'd hopefully be able to do them to gravity and use my trusty toomey syringe. :)

Bags are hung and changed Q24 for continuous.

Bags are used for intermittent such as 250mL at 100mL/hr in home care.

Bolus feeds are done with 60mL syringe via gravity (or slow bolus push if a puréed diet via GT instead of liquid formula)

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Specializes in Pediatric Critical Care.

The policy at every hospital that I have worked at is that formula can be used for up to 4 hours at room temp. So if I am taking care of a baby who is Q3 hour feeds.....well even if I dont rinse out the tubing, it is never going to be out for more than 4 hours. I dont know of a single coworker who rinses out the tubing for Q3 or Q4 hour feeds. The bag itself will be changed q24h.

Now, that is for formula; it is different for (non-pasteurized) breastmilk.

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When I worked in acute care the bag was good for 24 hours and we would just add cans as it became low. There was never any time in between though. All the others were bolus feedings by gravity. This was what I saw over the course of eight years. I had only seen intermittent tube feedings with a pump in home care.

The home care case that I work now is a continuous tube feeding. We put about 4 hours worth of feed into the bag (since the pump calibration isn't great even though it's been looked at by the company) and the orders from the PCP actually read to rinse the bag with soap and water after each four hour supply has been administered. The GT extensions are rinsed each time as well, as the plan of care reads.

As for the ice pack, I would not advise this. Cold feedings cause increased flatus, which will only increase their abdominal (gas) pain, which will increase the need to vent the GT for relief of gas pressure that could be avoided if given at room temperature.

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Specializes in Complex pedi to LTC/SA & now a manager.

I have one patient that actually tolerates cold feeds better! This is a unique kiddo and has less upper and lower gas when formula is cool or cold. Nearly everyone else needs ambient or warmed.

Toughest are puréed by GT, unless you enjoy wearing puréed mystery food but it helps in kiddos with vomiting post fundo (Cincinnati Children's had published research and the protocol if curious). I have two clients on PBGT variants.

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Specializes in Pediatric Critical Care.

Toughest are puréed by GT, unless you enjoy wearing puréed mystery food but it helps in kiddos with vomiting post fundo (Cincinnati Children's had published research and the protocol if curious). I have two clients on PBGT variants.

I took care of a boy that had feedings according to the Cincinnati Children's research....such a pain when he was hospitalized but they kept him growing when nothing else worked.

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Specializes in Pedi.
Think baby bottles. Never at room temp for more than 2 hrs. Have you ever smelled a used feeding bag after four hours?

I don't know why your coworker primes into the patient as that makes no sense.

My company P&P is rinse the bag with hot water then run ~100mL hot water either on pump at highest rate or prime until the line is "dry". All the wash water is discarded. (Wet or standing formula tubing increases risk for bacterial contamination)

Next time you don't wash out the bag take a whif. It doesn't take much for milk based formula to spoil. I had a toddler end up hospitalized with a significant GI infection because the one shift didn't think it was necessary to wash out the bags as it was only a couple of hours between feeds.

This.

OP, would you drink milk that's been sitting out for 3-4 hours? Didn't think so. When the feed finishes, there should be only a very small amount of milk left in the tubing of the bag. I would never prime it into the patient but do teach parents to clean the bag between bolus feedings. To do this, put warm water in the bag and prime it through by hand or pump until the formula has been cleared from the bag. I can't figure out how this could possibly take someone (who knows what she's doing) 30 minutes. It takes like 90 seconds. I have many patients who are on feeding regimens of, say, 250 mL q 4 hrs or 120 mL q 3 hrs. I wouldn't give a PO fed kid formula that's been sitting out for 4 hours, so why would I give a GT fed kid formula that's been sitting in a bag for 4 hours?

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I watched her again the other day and she insists on rinsing the bag until the water running through is completely clear. So she will run water through and rinse the bag about three times, which is what is taking so long. I really feel as though this is unnecessary and tedious. I need her teamwork as we are really busy in this school setting and there are so many other things to do! She also insists on pausing the feeding pump every time she leaves the pts side. I feel as though she is a little paranoid and is behaving like a germifobe. And if I try to make suggestions she ignores them.

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Specializes in Complex pedi to LTC/SA & now a manager.
I watched her again the other day and she insists on rinsing the bag until the water running through is completely clear. So she will run water through and rinse the bag about three times, which is what is taking so long. I really feel as though this is unnecessary and tedious. I need her teamwork as we are really busy in this school setting and there are so many other things to do! She also insists on pausing the feeding pump every time she leaves the pts side. I feel as though she is a little paranoid and is behaving like a germifobe. And if I try to make suggestions she ignores them.

Ok. I'd say walk away. She's being inefficient and wasting time. New grad? I don't think I could spend 30 minutes washing a bag if I used soap & a scrub brush!

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Specializes in Pediatric Critical Care.
She also insists on pausing the feeding pump every time she leaves the pts side.

Why is she pausing the feeding pump every time she walks away? Thats seems dumb. Whats her reason?

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Specializes in Complex pedi to LTC/SA & now a manager.
Why is she pausing the feeding pump every time she walks away? Thats seems dumb. Whats her reason?

Granted I have a PDN kiddo that if I walk away to use the restroom I have to pause and d/c the extension. But this kiddo is a spaghetti wrestler in sleep and will tangle in the tubing and pull out the GB.

In school kiddo's with continuous or hourly pump bolus feeds are secured in an adaptive chair with safety straps at an appropriate upright angle. The classroom staff calls if the pump alarms or if it's finished. Only paused if distressed, reflux, vomiting or coughing.

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because you can't compare "milk" to the canned liquid we feed by GT.

This.

OP, would you drink milk that's been sitting out for 3-4 hours? Didn't think so. When the feed finishes, there should be only a very small amount of milk left in the tubing of the bag. I would never prime it into the patient but do teach parents to clean the bag between bolus feedings. To do this, put warm water in the bag and prime it through by hand or pump until the formula has been cleared from the bag. I can't figure out how this could possibly take someone (who knows what she's doing) 30 minutes. It takes like 90 seconds. I have many patients who are on feeding regimens of, say, 250 mL q 4 hrs or 120 mL q 3 hrs. I wouldn't give a PO fed kid formula that's been sitting out for 4 hours, so why would I give a GT fed kid formula that's been sitting in a bag for 4 hours?

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